Methods and systems for recalibrating a blood pressure monitor with memory

ABSTRACT

Systems and methods are provided for storing and recalling metrics associated with physiological signals. It may be determined that the value of a monitored physiological metric corresponds to a stored value. In such cases, a patient monitor may determine that a calibration is not desired. In some cases, a patient monitor may recall calibration parameters associated with the stored value if it determined that the stored value corresponds to the monitored metric value.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.12/956,963, filed Nov. 30, 2010, which is incorporated by referenceherein in its entirety.

SUMMARY

Continuous non-invasive blood pressure (CNIBP) monitoring systems allowa patient's blood pressure to be tracked continuously, unlike standardocclusion cuff techniques, and without the hazards of invasive arteriallines. In some embodiments, multiple pulse oximetry type sensors may beplaced at multiple body sites on a patient to measurephotoplethysmograph (PPG) signals. The resulting multiple PPG signalsmay be compared against each other to estimate the patient's bloodpressure. When the locations of two sensors are at different distancesfrom the heart or along different paths from the heart (e.g., at thefinger and forehead), a differential pulse transit time (DPTT) may bedetermined. A DPTT may represent the difference in the arrival times ofa portion of a cardiac wave between the two locations, and may bedetermined by comparing corresponding fiducial points in the two PPGsignals (e.g., a maximum, minimum, or a notch). In some techniques, twoDPTTs are determined in order to calculate multiple physiologicalparameters, such as systolic and diastolic blood pressure. These DPTTsmay be determined during different phases of the PPG signal representingdifferent physiological occurrences. For example, one DPTT may bedetermined when the cardiovascular system is in a systolic state and asecond DPTT may be determined when the cardiovascular system is in adiastolic state.

During physiological monitoring of a patient with a patient monitoringsystem, recalibration of the patient monitoring system may be desired.For example, a CNIBP system may be periodically calibrated with a NIBPsystem. It may be desirous in some instances to reduce the number ofcalibrations that are performed. For example, an inflatable cuff typeNIBP system may be used to calibrate a PPG-based CNIBP system, and areduction in the number of cuff inflations may be desirous. In somecircumstances, performing a calibration is likely to result incalibration parameters similar to those of a previous calibration.

Systems and methods are provided herein for calibrating a patientmonitoring system with stored calibration parameters. Calibrationparameters may be stored in a suitable memory device, and recalledduring suitable calibration conditions. Values of one or more metricsassociated with one or more physiological signals (e.g., PPG signals)may be monitored by a patient monitoring system and compared with storedmetric values. If it is determined by the patient monitoring system thatthe value of the monitored metric corresponds to a stored metric value,the patient monitoring system may recall calibration parametersassociated with the stored value.

In some embodiments, for example, metrics may be stored in any suitabledatabase. Calibration parameters associated with the stored metrics mayalso be stored in any suitable database (e.g., the same database wherethe metrics are stored). Metrics may include signal morphologyparameters such as, for example, pulse wave area, pulse wave skew,derivatives of a signal, heart rate, length of a pulse upstroke, anyother suitable metric or any combination thereof. Metrics derived from aphysiological signal may change due to, for example, effects ofvasoactive drugs, patient movement, or other factors which may changearterial compliance.

In some embodiments, a patient monitoring system may monitor one or moremetrics derived from a physiological signal. One or more metrics of thephysiological signal may change over time due to any suitable cause orcombination of causes. In some circumstances, following the temporalchange in the one or more metrics, the values of the one or more metricsmay return to or about their past values as computed prior to thechange. The patient monitoring system may then recall stored calibrationparameters associated with the past values rather than performing anactual recalibration. For example, a CNIBP device calibrated withinitial calibration parameters may be used to monitor a physiologicalmetric associated with a patient. At a particular time, a vasoactivedrug may be administered, and the value of the metric may change. At aparticular time after the drug was administered, the value of the metricmay return to the metric's value prior to the drug administration. Thepatient monitoring system may, in response to the return of the metric'svalue, revert to the stored initial calibration parameters rather thaninitiating a new NIBP (e.g., cuff device) calibration to determine newcalibration parameters.

The methods and systems of the present disclosure will be illustratedwith reference to the monitoring of a physiological signal (which may bea PPG signal). However, it will be understood that the disclosure is notlimited to monitoring physiological signals and is usefully appliedwithin a number of signal monitoring settings.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other features of the present disclosure, its nature andvarious advantages will be more apparent upon consideration of thefollowing detailed description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 shows an illustrative patient monitoring system in accordancewith an embodiment;

FIG. 2 shows a block diagram of the illustrative patient monitoringsystem of FIG. 1 coupled to a patient in accordance with an embodiment;

FIG. 3 shows a block diagram of an illustrative signal processing systemin accordance with an embodiment;

FIG. 4 shows an illustrative signal which may be analyzed in accordancewith an embodiment;

FIG. 5( a) shows an illustrative time series of a blood pressuremeasurement in accordance with an embodiment;

FIG. 5( b) shows an illustrative portion of a PPG signal correspondingto some data of FIG. 5( a) in accordance with an embodiment;

FIG. 5( c) shows an illustrative portion of a PPG signal correspondingto some data of FIG. 5( a) in accordance with an embodiment;

FIG. 5( d) shows an illustrative portion of a PPG signal correspondingto some data of FIG. 5( a) in accordance with an embodiment;

FIG. 6 shows a superposition of illustrative PPG signals of FIGS. 5(b)-5(d) in accordance with an embodiment;

FIG. 7 is a block diagram of an illustrative database in accordance withan embodiment;

FIG. 8 is a flow diagram of illustrative steps for updating monitoringsystem calibration parameters in accordance with an embodiment;

FIG. 9 is a flow diagram of illustrative steps for storing physiologicalsignals and metrics in accordance with an embodiment; and

FIG. 10 is a flow diagram of illustrative steps for storingphysiological signals and metrics associated with a calibration inaccordance with an embodiment.

DETAILED DESCRIPTION

An oximeter is a medical device that may determine the oxygen saturationof the blood. One common type of oximeter is a pulse oximeter, which mayindirectly measure the oxygen saturation of a patient's blood (asopposed to measuring oxygen saturation directly by analyzing a bloodsample taken from the patient). Pulse oximeters may be included inpatient monitoring systems that measure and display various blood flowcharacteristics including, but not limited to, the oxygen saturation ofhemoglobin in arterial blood. Such patient monitoring systems may alsomeasure and display additional physiological parameters, such as apatient's pulse rate and blood pressure.

An oximeter may include a light sensor that is placed at a site on apatient, typically a fingertip, toe, forehead or earlobe, or in the caseof a neonate, across a foot. The oximeter may use a light source to passlight through blood perfused tissue and photoelectrically sense theabsorption of the light in the tissue. In addition, locations which arenot typically understood to be optimal for pulse oximetry serve assuitable sensor locations for the blood pressure monitoring processesdescribed herein, including any location on the body that has a strongpulsatile arterial flow. For example, additional suitable sensorlocations include, without limitation, the neck to monitor carotidartery pulsatile flow, the wrist to monitor radial artery pulsatileflow, the inside of a patient's thigh to monitor femoral arterypulsatile flow, the ankle to monitor tibial artery pulsatile flow, andaround or in front of the ear. Suitable sensors for these locations mayinclude sensors for sensing absorbed light based on detecting reflectedlight. In all suitable locations, for example, the oximeter may measurethe intensity of light that is received at the light sensor as afunction of time. The oximeter may also include sensors at multiplelocations. A signal representing light intensity versus time or amathematical manipulation of this signal (e.g., a scaled versionthereof, a log taken thereof, a scaled version of a log taken thereof,etc.) may be referred to as the photoplethysmograph (PPG) signal. Inaddition, the term “PPG signal,” as used herein, may also refer to anabsorption signal (i.e., representing the amount of light absorbed bythe tissue) or any suitable mathematical manipulation thereof. The lightintensity or the amount of light absorbed may then be used to calculateany of a number of physiological parameters, including an amount of ablood constituent (e.g., oxyhemoglobin) being measured as well as apulse rate and when each individual pulse occurs.

In some applications, the light passed through the tissue is selected tobe of one or more wavelengths that are absorbed by the blood in anamount representative of the amount of the blood constituent present inthe blood. The amount of light passed through the tissue varies inaccordance with the changing amount of blood constituent in the tissueand the related light absorption. Red and infrared (IR) wavelengths maybe used because it has been observed that highly oxygenated blood willabsorb relatively less Red light and more IR light than blood with alower oxygen saturation. By comparing the intensities of two wavelengthsat different points in the pulse cycle, it is possible to estimate theblood oxygen saturation of hemoglobin in arterial blood.

When the measured blood parameter is the oxygen saturation ofhemoglobin, a convenient starting point assumes a saturation calculationbased at least in part on Lambert-Beer's law. The following notationwill be used herein:I(λ,t)=I _(o)(λ)exp(−(sβ _(o)(λ)+(1−s)β_(r)(λ))l(t))  (1)where:

-   λ=wavelength;-   t=time;-   I=intensity of light detected;-   I_(o)=intensity of light transmitted;-   s=oxygen saturation;-   β_(o),β_(r)=empirically derived absorption coefficients; and-   l(t)=a combination of concentration and path length from emitter to    detector as a function of time.

The traditional approach measures light absorption at two wavelengths(e.g., Red and IR), and then calculates saturation by solving for the“ratio of ratios” as follows.

-   1. The natural logarithm of Eq. 1 is taken (“log” will be used to    represent the natural logarithm) for IR and Red to yield    log I=log I _(o)−(sβ _(o)+(1−s)β_(r))l.  (2)-   2. Eq. 2 is then differentiated with respect to time to yield

$\begin{matrix}{\frac{{\mathbb{d}\log}\; I}{\mathbb{d}t} = {{- \left( {{s\;\beta_{O}} + {\left( {1 - s} \right)\beta_{r}}} \right)}{\frac{\mathbb{d}l}{\mathbb{d}t}.}}} & (3)\end{matrix}$

-   3. Eq. 3, evaluated at the Red wavelength λ_(R), is divided by Eq. 3    evaluated at the IR wavelength λ_(IR) in accordance with

$\begin{matrix}{\frac{{\mathbb{d}\log}\;{{I\left( \lambda_{R} \right)}/{\mathbb{d}t}}}{{\delta log}\;{{I\left( \lambda_{IR} \right)}/{\mathbb{d}t}}} = {\frac{{s\;{\beta_{O}\left( \lambda_{R} \right)}} + {\left( {1 - s} \right){\beta_{r}\left( \lambda_{R} \right)}}}{{s\;{\beta_{O}\left( \lambda_{IR} \right)}} + {\left( {1 - s} \right){\beta_{r}\left( \lambda_{IR} \right)}}}.}} & (4)\end{matrix}$

-   4. Solving for s yields

$\begin{matrix}{s = {\frac{{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{IR} \right)}}{\mathbb{d}t}{\beta_{r}\left( \lambda_{R} \right)}} - {\frac{{\mathbb{d}\log}\;{I\left( \lambda_{R} \right)}}{\mathbb{d}t}{\beta_{r}\left( \lambda_{IR} \right)}}}{\begin{matrix}{{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{R} \right)}}{\mathbb{d}t}\left( {{\beta_{O}\left( \lambda_{IR} \right)} - {\beta_{r}\left( \lambda_{IR} \right)}} \right)} -} \\{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{R} \right)}}{\mathbb{d}t}\left( {{\beta_{O}\left( \lambda_{R} \right)} - {\beta_{r}\left( \lambda_{R} \right)}} \right)}\end{matrix}}.}} & (5)\end{matrix}$

-   5. Note that, in discrete time, the following approximation can be    made:

$\begin{matrix}{\frac{{\mathbb{d}\log}\;{I\left( {\lambda,t} \right)}}{\mathbb{d}t} \simeq {{\log\;{I\left( {\lambda,t_{2}} \right)}} - {\log\;{{I\left( {\lambda,t_{1}} \right)}.}}}} & (6)\end{matrix}$

-   6. Rewriting Eq. 6 by observing that log A−log B=log(A/B) yields

$\begin{matrix}{\frac{{\mathbb{d}\log}\;{I\left( {\lambda,t} \right)}}{\mathbb{d}t} \simeq {{\log\left( \frac{I\left( {t_{2},\lambda} \right)}{I\left( {t_{1},\lambda} \right)} \right)}.}} & (7)\end{matrix}$

-   7. Thus, Eq. 4 can be expressed as

$\begin{matrix}{{{\frac{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{R} \right)}}{\mathbb{d}t}}{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{IR} \right)}}{\mathbb{d}t}} \simeq \frac{\log\left( \frac{I\left( {t_{1},\lambda_{R}} \right)}{I\left( {t_{2},\lambda_{R}} \right)} \right)}{\log\left( \frac{I\left( {t_{1},\lambda_{IR}} \right)}{I\left( {t_{2},\lambda_{IR}} \right)} \right)}} = R},} & (8)\end{matrix}$where R represents the “ratio of ratios.”

-   8. Solving Eq. 4 for s using the relationship of Eq. 5 yields

$\begin{matrix}{s = {\frac{{\beta_{r}\left( \lambda_{R} \right)} - {R\;{\beta_{r}\left( \lambda_{IR} \right)}}}{{R\left( {{\beta_{O}\left( \lambda_{IR} \right)} - {\beta_{r}\left( \lambda_{IR} \right)}} \right)} - {\beta_{O}\left( \lambda_{R} \right)} + {\beta_{r}\left( \lambda_{R} \right)}}.}} & (9)\end{matrix}$

-   9. From Eq. 8, R can be calculated using two points (e.g., PPG    maximum and minimum), or a family of points. One method applies a    family of points to a modified version of Eq. 8. Using the    relationship

$\begin{matrix}{{\frac{{\mathbb{d}\log}\; I}{\mathbb{d}t} = \frac{{\mathbb{d}I}/{\mathbb{d}t}}{I}},} & (10)\end{matrix}$Eq. 8 becomes

$\begin{matrix}\begin{matrix}{\frac{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{R} \right)}}{\mathbb{d}t}}{\frac{{\mathbb{d}\log}\;{I\left( \lambda_{IR} \right)}}{\mathbb{d}t}} \simeq \frac{\frac{{I\left( {t_{2},\lambda_{R}} \right)} - {I\left( {t_{1},\lambda_{R}} \right)}}{I\left( {t_{1},\lambda_{R}} \right)}}{\frac{{I\left( {t_{2},\lambda_{IR}} \right)} - {I\left( {t_{1},\lambda_{IR}} \right)}}{I\left( {t_{1},\lambda_{IR}} \right)}}} \\{= \frac{\left\lbrack {{I\left( {t_{2},\lambda_{R}} \right)} - {I\left( {t_{1},\lambda_{R}} \right)}} \right\rbrack{I\left( {t_{1},\lambda_{IR}} \right)}}{\left\lbrack {{I\left( {t_{2},\lambda_{IR}} \right)} - {I\left( {t_{1},\lambda_{IR}} \right)}} \right\rbrack{I\left( {t_{1},\lambda_{R}} \right)}}} \\{{= R},}\end{matrix} & (11)\end{matrix}$which defines a cluster of points whose slope of y versus x will give Rwhenx=[I(t ₂,λ_(IR))−I(t ₁,λ_(IR))]I(t ₁,λ_(R)),  (12)andy=[I(t ₂,λ_(R))−I(t ₁,λ_(R))]I(t ₁,λ_(IR)).  (13)Once R is determined or estimated, for example, using the techniquesdescribed above, the blood oxygen saturation can be determined orestimated using any suitable technique for relating a blood oxygensaturation value to R. For example, blood oxygen saturation can bedetermined from empirical data that may be indexed by values of R,and/or it may be determined from curve fitting and/or otherinterpolative techniques.

FIG. 1 is a perspective view of an embodiment of a patient monitoringsystem 10. System 10 may include sensor unit 12 and monitor 14. In anembodiment, sensor unit 12 may be part of a continuous, non-invasiveblood pressure (CNIBP) monitoring system and/or an oximeter. Sensor unit12 may include an emitter 16 for emitting light at one or morewavelengths into a patient's tissue. A detector 18 may also be providedin sensor 12 for detecting the light originally from emitter 16 thatemanates from the patient's tissue after passing through the tissue. Anysuitable physical configuration of emitter 16 and detector 18 may beused. In an embodiment, sensor unit 12 may include multiple emittersand/or detectors, which may be spaced apart. System 10 may also includeone or more additional sensor units, such as sensor unit 13, which maytake the form of any of the embodiments described herein with referenceto sensor unit 12. For example, sensor unit 13 may include emitter 15and detector 19. Sensor unit 13 may be the same type of sensor unit assensor unit 12, or sensor unit 13 may be of a different sensor unit typethan sensor unit 12. Sensor units 12 and 13 may be capable of beingpositioned at two different locations on a subject's body; for example,sensor unit 12 may be positioned on a patient's forehead, while sensorunit 13 may be positioned at a patient's fingertip.

Sensor units 12 and 13 may each detect any signal that carriesinformation about a patient's physiological state, such as anelectrocardiograph signal, arterial line measurements, or the pulsatileforce exerted on the walls of an artery using, for example,oscillometric methods with a piezoelectric transducer. According toanother embodiment, system 10 may include a plurality of sensors forminga sensor array in lieu of either or both of sensor units 12 and 13. Eachof the sensors of a sensor array may be a complementary metal oxidesemiconductor (CMOS) sensor. Alternatively, each sensor of an array maybe charged coupled device (CCD) sensor. In an embodiment, a sensor arraymay be made up of a combination of CMOS and CCD sensors. The CCD sensormay comprise a photoactive region and a transmission region forreceiving and transmitting data whereas the CMOS sensor may be made upof an integrated circuit having an array of pixel sensors. Each pixelmay have a photodetector and an active amplifier. It will be understoodthat any type of sensor, including any type of physiological sensor, maybe used in one or more of sensor units 12 and 13 in accordance with thesystems and techniques disclosed herein. It is understood that anynumber of sensors measuring any number of physiological signals may beused to determine physiological information in accordance with thetechniques described herein.

According to an embodiment, emitter 16 and detector 18 may be onopposite sides of a digit such as a finger or toe, in which case thelight that is emanating from the tissue has passed completely throughthe digit. In an embodiment, emitter 16 and detector 18 may be arrangedso that light from emitter 16 penetrates the tissue and is reflected bythe tissue into detector 18, such as in a sensor designed to obtainpulse oximetry data from a patient's forehead.

In an embodiment, sensor unit 12 may be connected to and draw its powerfrom monitor 14 as shown. In another embodiment, the sensor may bewirelessly connected to monitor 14 and include its own battery orsimilar power supply (not shown). Monitor 14 may be configured tocalculate physiological parameters (e.g., heart rate, blood pressure,blood oxygen saturation) based at least in part on data relating tolight emission and detection received from one or more sensor units suchas sensor units 12 and 13. In an alternative embodiment, thecalculations may be performed on the sensor units or an intermediatedevice and the result of the calculations may be passed to monitor 14.Further, monitor 14 may include a display 20 configured to display thephysiological parameters or other information about the system. In theembodiment shown, monitor 14 may also include a speaker 22 to provide anaudible sound that may be used in various other embodiments, such as forexample, sounding an audible alarm in the event that a patient'sphysiological parameters are not within a predefined normal range. In anembodiment, the monitor 14 includes a blood pressure monitor. Inalternative embodiments, the system 10 includes a stand-alone bloodpressure monitor in communication with the monitor 14 via a cable or awireless network link.

In an embodiment, sensor unit 12 may be communicatively coupled tomonitor 14 via a cable 24. However, in other embodiments, a wirelesstransmission device (not shown) or the like may be used instead of or inaddition to cable 24.

In the illustrated embodiment, system 10 includes a multi-parameterpatient monitor 26. The monitor 26 may include a cathode ray tubedisplay, a flat panel display (as shown) such as a liquid crystaldisplay (LCD) or a plasma display, or may include any other type ofmonitor now known or later developed. Multi-parameter patient monitor 26may be configured to calculate physiological parameters and to provide adisplay 28 for information from monitor 14 and from other medicalmonitoring devices or systems (not shown). For example, multi-parameterpatient monitor 26 may be configured to display an estimate of apatient's blood oxygen saturation generated by monitor 14 (referred toas an “SpO₂” measurement), pulse rate information from monitor 14 andblood pressure from monitor 14 on display 28. Multi-parameter patientmonitor 26 may include a speaker 30.

Monitor 14 may be communicatively coupled to multi-parameter patientmonitor 26 via a cable 32 or 34 that is coupled to a sensor input portor a digital communications port, respectively and/or may communicatewirelessly (not shown). In addition, monitor 14 and/or multi-parameterpatient monitor 26 may be coupled to a network to enable the sharing ofinformation with servers or other workstations (not shown). Monitor 14may be powered by a battery (not shown) or by a conventional powersource such as a wall outlet.

Calibration device 80, which may be powered by monitor 14 via a cable82, a battery, or by a conventional power source such as a wall outlet,may include any suitable signal calibration device. Calibration device80 may be communicatively coupled to monitor 14 via cable 82, and/or maycommunicate wirelessly (not shown). In other embodiments, calibrationdevice 80 is completely integrated within monitor 14. For example,calibration device 80 may take the form of any invasive or non-invasiveblood pressure monitoring or measuring system used to generate referenceblood pressure measurements for use in calibrating a CNIBP monitoringtechnique as described herein. Such calibration devices may include, forexample, an aneroid or mercury sphygmomanometer and occluding cuff, apressure sensor inserted directly into a suitable artery of a patient,an oscillometric device or any other device or mechanism used to sense,measure, determine, or derive a reference blood pressure measurement. Insome embodiments, calibration device 80 may include a manual inputdevice (not shown) used by an operator to manually input referencesignal measurements obtained from some other source (e.g., an externalinvasive or non-invasive physiological measurement system).

Calibration device 80 may also access reference signal measurementsstored in memory (e.g., RAM, ROM, or a storage device). For example, insome embodiments, calibration device 80 may access reference bloodpressure measurements from a relational database stored withincalibration device 80, monitor 14, or multi-parameter patient monitor26. The reference blood pressure measurements generated or accessed bycalibration device 80 may be updated in real-time, resulting in acontinuous source of reference blood pressure measurements for use incontinuous or periodic calibration. Alternatively, reference bloodpressure measurements generated or accessed by calibration device 80 maybe updated periodically, and calibration may be performed on the sameperiodic cycle or a different periodic cycle. Reference blood pressuremeasurements may be generated when recalibration is triggered.

FIG. 2 is a block diagram of a patient monitoring system, such aspatient monitoring system 10 of FIG. 1, which may be coupled to apatient 40 in accordance with an embodiment. Certain illustrativecomponents of sensor unit 12 and monitor 14 are illustrated in FIG. 2.Because sensor units 12 and 13 may include similar components andfunctionality, only sensor unit 12 will be discussed in detail for easeof illustration. It will be understood that any of the concepts,components, and operation discussed in connection with sensor unit 12may be applied to sensor unit 13 as well (e.g., emitter 16 and detector18 of sensor unit 12 may be similar to emitter 15 and detector 19 ofsensor unit 13). It will be noted that patient monitoring system 10 mayinclude one or more additional sensor units or probes, which may takethe form of any of the embodiments described herein with reference tosensor units 12 and 13 (FIG. 1). These additional sensor units includedin system 10 may take the same form as sensor unit 12, or may take adifferent form. In an embodiment, multiple sensors (distributed in oneor more sensor units) may be located at multiple different body sites ona patient.

Sensor unit 12 may include emitter 16, detector 18, and encoder 42. Inthe embodiment shown, emitter 16 may be configured to emit at least twowavelengths of light (e.g., Red and IR) into a patient's tissue 40.Hence, emitter 16 may include a Red light emitting light source such asRed light emitting diode (LED) 44 and an IR light emitting light sourcesuch as IR LED 46 for emitting light into the patient's tissue 40 at thewavelengths used to calculate the patient's physiological parameters. Inone embodiment, the Red wavelength may be between about 600 nm and about700 nm, and the IR wavelength may be between about 800 nm and about 1000nm. In embodiments where a sensor array is used in place of a singlesensor, each sensor may be configured to emit a single wavelength. Forexample, a first sensor emits only a Red light while a second emits onlyan IR light. In another example, the wavelengths of light used areselected based on the specific location of the sensor.

It will be understood that, as used herein, the term “light” may referto energy produced by radiation sources and may include one or more ofultrasound, radio, microwave, millimeter wave, infrared, visible,ultraviolet, gamma ray or X-ray electromagnetic radiation. As usedherein, light may also include electromagnetic radiation having anywavelength within the radio, microwave, infrared, visible, ultraviolet,or X-ray spectra, and that any suitable wavelength of electromagneticradiation may be appropriate for use with the present techniques.Detector 18 may be chosen to be specifically sensitive to the chosentargeted energy spectrum of the emitter 16.

In an embodiment, detector 18 may be configured to detect the intensityof light at the Red and IR wavelengths. Alternatively, each sensor inthe array may be configured to detect an intensity of a singlewavelength. In operation, light may enter detector 18 after passingthrough the patient's tissue 40. Detector 18 may convert the intensityof the received light into an electrical signal. The light intensity isdirectly related to the absorbance and/or reflectance of light in thetissue 40. That is, when more light at a certain wavelength is absorbedor reflected, less light of that wavelength is received from the tissueby the detector 18. After converting the received light to an electricalsignal, detector 18 may send the signal to monitor 14, wherephysiological parameters may be calculated based on the absorption ofthe Red and IR wavelengths in the patient's tissue 40.

In an embodiment, encoder 42 may contain information about sensor 12,such as what type of sensor it is (e.g., whether the sensor is intendedfor placement on a forehead or digit) and the wavelengths of lightemitted by emitter 16. This information may be used by monitor 14 toselect appropriate algorithms, lookup tables and/or calibrationcoefficients stored in monitor 14 for calculating the patient'sphysiological parameters.

Encoder 42 may contain information specific to patient 40, such as, forexample, the patient's age, weight, and diagnosis. This informationabout a patient's characteristics may allow monitor 14 to determine, forexample, patient-specific threshold ranges in which the patient'sphysiological parameter measurements should fall and to enable ordisable additional physiological parameter algorithms. This informationmay also be used to select and provide coefficients for equations fromwhich, for example, blood pressure and other measurements may bedetermined based at least in part on the signal or signals received atsensor unit 12. For example, some pulse oximetry sensors rely onequations to relate an area under a portion of a photoplethysmograph(PPG) signal corresponding to a physiological pulse to determine bloodpressure. These equations may contain coefficients that depend upon apatient's physiological characteristics as stored in encoder 42. Encoder42 may, for instance, be a coded resistor which stores valuescorresponding to the type of sensor unit 12 or the type of each sensorin the sensor array, the wavelengths of light emitted by emitter 16 oneach sensor of the sensor array, and/or the patient's characteristics.In another embodiment, encoder 42 may include a memory on which one ormore of the following information may be stored for communication tomonitor 14: the type of the sensor unit 12; the wavelengths of lightemitted by emitter 16; the particular wavelength each sensor in thesensor array is monitoring; a signal threshold for each sensor in thesensor array; any other suitable information; or any combinationthereof.

In an embodiment, signals from detector 18 and encoder 42 may betransmitted to monitor 14. In the embodiment shown, monitor 14 mayinclude a general-purpose microprocessor 48 connected to an internal bus50. Microprocessor 48 may be adapted to execute software, which mayinclude an operating system and one or more applications, as part ofperforming the functions described herein. Also connected to bus 50 maybe a read-only memory (ROM) 52, remote memory 90, a random access memory(RAM) 54, user inputs 56, display 20, and speaker 22.

RAM 54 and ROM 52 are illustrated by way of example, and not limitation.Any suitable computer-readable media may be used in the system for datastorage. Computer-readable media are capable of storing information thatcan be interpreted by microprocessor 48. This information may be data ormay take the form of computer-executable instructions, such as softwareapplications, that cause the microprocessor to perform certain functionsand/or computer-implemented methods. Depending on the embodiment, suchcomputer-readable media may include computer storage media andcommunication media. Computer storage media may include volatile andnon-volatile, removable and non-removable media implemented in anymethod or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. Computer storage media may include, but is not limited to,RAM, ROM, EPROM, EEPROM, flash memory or other solid state memorytechnology, CD-ROM, DVD, or other optical storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by components of the system.

Remote memory 90 may include any suitable volatile memory, non-volatilememory, or any combination thereof. Remote memory 90 may include, but isnot limited to, RAM, ROM, EPROM, EEPROM, flash memory or other solidstate memory technology, CD-ROM, DVD, or other optical storage, magneticcassettes, magnetic tape, magnetic disk storage or other magneticstorage devices, or any other medium which can be used to store thedesired information and which can be accessed by components of thesystem. In some embodiments, remote memory 90 may be separate and remotefrom other components included in the patient monitoring system. Forexample, in some embodiments, remote memory 90 may be included in adatabase server, application server, remote processing facility ordevice, cloud-based information storage system, any other suitableaccessible information storage system or device, or any suitablecombination thereof.

Communications path 92 may, in some embodiments, couple remote memory 90to bus 50 via a suitable interface, or any other suitable component ofpatient monitoring system 10. Communication path 92 may include anysuitable type of wired network (e.g., local area network, ethernet,universal serial bus), wireless network (e.g., WiFi, Global System forMobile Communication, BLUETOOTH), optical communications path (e.g., afiber optic network), any other suitable communications path, or anysuitable combination thereof.

In the embodiment shown, a time processing unit (TPU) 58 may providetiming control signals to light drive circuitry 60, which may controlwhen emitter 16 is illuminated and multiplexed timing for Red LED 44 andIR LED 46. TPU 58 may also control the gating-in of signals fromdetector 18 through amplifier 62 and switching circuit 64. These signalsare sampled at the proper time, depending upon which light source isilluminated. The received signal from detector 18 may be passed throughamplifier 66, low pass filter 68, and analog-to-digital converter 70.The digital data may then be stored in a queued serial module (QSM) 72(or buffer) for later downloading to RAM 54 as QSM 72 fills up. In oneembodiment, there may be multiple separate parallel paths havingcomponents equivalent to amplifier 66, filter 68, and/or A/D converter70 for multiple light wavelengths or spectra received.

In an embodiment, microprocessor 48 may determine the patient'sphysiological parameters, such as SpO₂, pulse rate, and/or bloodpressure, using various algorithms and/or look-up tables based on thevalue of the received signals and/or data corresponding to the lightreceived by detector 18. Signals corresponding to information aboutpatient 40, and particularly about the intensity of light emanating froma patient's tissue over time, may be transmitted from encoder 42 todecoder 74. These signals may include, for example, encoded informationrelating to patient characteristics. Decoder 74 may translate thesesignals to enable the microprocessor to determine the thresholds basedat least in part on algorithms or look-up tables stored in ROM 52. Userinputs 56 may be used to enter information about the patient, such asage, weight, height, diagnosis, medications, treatments, and so forth.In an embodiment, display 20 may exhibit a list of values which maygenerally apply to the patient, such as, for example, age ranges ormedication families, which the user may select using user inputs 56.

The optical signal through the tissue can be degraded by noise, amongother sources. One source of noise is ambient light that reaches thelight detector. Another source of noise is electromagnetic coupling fromother electronic instruments. Movement of the patient also introducesnoise and affects the signal. For example, the contact between thedetector and the skin, or the emitter and the skin, can be temporarilydisrupted when movement causes either to move away from the skin. Inaddition, because blood is a fluid, it responds differently than thesurrounding tissue to inertial effects, thus resulting in momentarychanges in volume at the point to which the oximeter probe is attached.

Noise (e.g., from patient movement) can degrade a sensor signal reliedupon by a care provider, without the care provider's awareness. This isespecially true if the monitoring of the patient is remote, the motionis too small to be observed, or the care provider is watching theinstrument or other parts of the patient, and not the sensor site.Processing sensor signals (e.g., PPG signals) may involve operationsthat reduce the amount of noise present in the signals or otherwiseidentify noise components in order to prevent them from affectingmeasurements of physiological parameters derived from the sensorsignals.

Pulse oximeters, in addition to providing other information, can beutilized for continuous non-invasive blood pressure monitoring. Asdescribed in Chen et al., U.S. Pat. No. 6,599,251, the entirety of whichis incorporated herein by reference, PPG and other pulse signalsobtained from multiple probes can be processed to calculate the bloodpressure of a patient. In particular, blood pressure measurements may bederived based on a comparison of time differences between certaincomponents of the pulse signals detected at each of the respectiveprobes. As described in U.S. patent application Ser. No. 12/242,238,filed on Sep. 30, 2008 and entitled “Systems and Methods ForNon-Invasive Blood Pressure Monitoring,” the entirety of which isincorporated herein by reference, blood pressure can also be derived byprocessing time delays detected within a single PPG or pulse signalobtained from a single pulse oximeter probe. In addition, as describedin U.S. patent application Ser. No. 12/242,867, filed on Sep. 30, 2008and entitled “Systems and Methods For Non-Invasive Continuous BloodPressure Determination,” the entirety of which is incorporated herein byreference, blood pressure may also be obtained by calculating the areaunder certain portions of a pulse signal. Finally, as described in U.S.patent application Ser. No. 12/242,862, filed on Sep. 30, 2008 andentitled “Systems and Methods For Maintaining Blood Pressure MonitorCalibration,” the entirety of which is incorporated herein by reference,a blood pressure monitoring device may be recalibrated in response toarterial compliance changes.

As described above, some CNIBP monitoring techniques utilize two probesor sensors positioned at two different locations on a subject's body.The elapsed time, T, between the arrivals of corresponding points of apulse signal at the two locations may then be determined using signalsobtained by the two probes or sensors. The estimated blood pressure, p,may then be related to the elapsed time, T, byp=a+b·ln(T)  (14)where a and b are constants that may be dependent upon the nature of thesubject and the nature of the signal detecting devices. Other suitableequations using an elapsed time between corresponding points of a pulsesignal may also be used to derive an estimated blood pressuremeasurement.

In an embodiment, Eq. 14 may include a non-linear function which ismonotonically decreasing and concave upward in T in a manner specifiedby the constant parameters (in addition to or instead of the expressionof Eq. 14). Eq. 14 may be used to calculate an estimated blood pressurefrom the time difference T between corresponding points of a pulsesignal received by two sensors or probes attached to two differentlocations of a subject.

In an embodiment, constants a and b in Eq. 14 above may be determined byperforming a calibration. The calibration may involve taking a referenceblood pressure reading to obtain a reference blood pressure P₀,measuring the elapsed time T₀ corresponding to the reference bloodpressure, and then determining values for both of the constants a and bfrom the reference blood pressure and elapsed time measurement.Calibration may be performed at any suitable time (e.g., once initiallyafter monitoring begins) or on any suitable schedule (e.g., a periodicor event-driven schedule).

In an embodiment, the calibration may include performing calculationsmathematically equivalent to

$\begin{matrix}{{a = {c_{1} + \frac{c_{2}\left( {P_{0} - c_{1}} \right)}{{\ln\left( T_{0} \right)} + c_{2}}}}{and}} & (15) \\{b = \frac{P_{0} - c_{1}}{{\ln\left( T_{0} \right)} + c_{2}}} & (16)\end{matrix}$to obtain values for the constants a and b, where c₁ and c₂ areparameters that may be determined, for example, based on empirical data.

In an embodiment, the calibration may include performing calculationsmathematically equivalent toa=P ₀−(c ₃ T ₀ +c ₄)ln(T ₀)  (17)andb=c ₃ T ₀ +c ₄  (18)where a and b are first and second parameters and c₃ and c₄ areparameters that may be determined, for example, based on empirical data.

Parameters c₁, c₂, c₃, and c₄ may be predetermined constants empiricallyderived using experimental data from a number of different patients. Asingle reference blood pressure reading from a patient, includingreference blood pressure P_(o) and elapsed time T_(o) from one or moresignals corresponding to that reference blood pressure, may be combinedwith such inter-patient data to calculate the blood pressure of apatient. The values of P₀ and T₀ may be referred to herein as acalibration point. According to this example, a single calibration pointmay be used with the predetermined constant parameters to determinevalues of constants a and b for the patient (e.g., using Eqs. 15 and 16or 17 and 18). The patient's blood pressure may then be calculated usingEq. 14. Recalibration may be performed by collecting a new calibrationpoint and recalculating the constants a and b used in Eq. 14.Calibration and recalibration may be performed using calibration device80 (FIG. 1).

In an embodiment, multiple calibration points from a patient may be usedto determine the relationship between the patient's blood pressure andone or more PPG signals. This relationship may be linear or non-linearand may be extrapolated and/or interpolated to define the relationshipover the range of the collected recalibration data. For example, themultiple calibration points may be used to determine values forparameters c₁ and c₂ or c₃ and c₄ (described above). These determinedvalues will be based on information about the patient (intra-patientdata) instead of information that came from multiple patients(inter-patient data). As another example, the multiple calibrationpoints may be used to determine values for parameters a and b (describedabove). Instead of calculating values of parameters a and b using asingle calibration point and predetermined constants, values forparameters a and b may be empirically derived from the values of themultiple calibration points. As yet another example, the multiplecalibration points may be used directly to determine the relationshipbetween blood pressure and PPG signals. Instead of using a predefinedrelationship (e.g., the relationship defined by Eq. 14), a relationshipmay be directly determined from the calibration points.

Additional examples of continuous and non-invasive blood pressuremonitoring techniques are described in Chen et al., U.S. Pat. No.6,566,251, which is hereby incorporated by reference herein in itsentirety. The technique described by Chen et al. may use two sensors(e.g., ultrasound or photoelectric pulse wave sensors) positioned at anytwo locations on a subject's body where pulse signals are readilydetected. For example, sensors may be positioned on an earlobe and afinger, an earlobe and a toe, or a finger and a toe of a patient's body.

FIG. 3 is an illustrative signal processing system 300 in accordancewith an embodiment that may implement the non-invasive blood pressuretechniques described herein. In this embodiment, input signal generator310 generates an input signal 316. As illustrated, input signalgenerator 310 may include pre-processor 320 coupled to sensor 318, whichmay provide input signal 316. In an embodiment, pre-processor 320 may bean oximeter and input signal 316 may be a PPG signal. In an embodiment,pre-processor 320 may be any suitable signal processing device and inputsignal 316 may include one or more PPG signals and one or more otherphysiological signals, such as an electrocardiogram (ECG) signal. Itwill be understood that input signal generator 310 may include anysuitable signal source, signal generating data, signal generatingequipment, or any combination thereof to produce signal 316. Signal 316may be a single signal, or may be multiple signals transmitted over asingle pathway or multiple pathways.

Pre-processor 320 may apply one or more signal processing operations tothe signal generated by sensor 318. For example, pre-processor 320 mayapply a pre-determined set of processing operations to the signalprovided by sensor 318 to produce input signal 316 that can beappropriately interpreted by processor 312, such as performing A/Dconversion. Pre-processor 320 may also perform any of the followingoperations on the signal provided by sensor 318: reshaping the signalfor transmission, multiplexing the signal, modulating the signal ontocarrier signals, compressing the signal, encoding the signal, andfiltering the signal.

In an embodiment, signal 316 may include PPG signals at one or morefrequencies, such as a Red PPG signal and an IR PPG signal. In anembodiment, signal 316 may include signals measured at one or more siteson a patient's body, for example, a patient's finger, toe, ear, arm, orany other body site. In an embodiment, signal 316 may include multipletypes of signals (e.g., one or more of an ECG signal, an EEG signal, anacoustic signal, an optical signal, a signal representing a bloodpressure, and a signal representing a heart rate). Signal 316 may be anysuitable biosignal or signals, such as, for example, electrocardiogram,electroencephalogram, electrogastrogram, electromyogram, heart ratesignals, pathological sounds, ultrasound, or any other suitablebiosignal. The systems and techniques described herein are alsoapplicable to any dynamic signals, non-destructive testing signals,condition monitoring signals, fluid signals, geophysical signals,astronomical signals, electrical signals, financial signals includingfinancial indices, sound and speech signals, chemical signals,meteorological signals including climate signals, any other suitablesignal, and/or any combination thereof.

In an embodiment, signal 316 may be coupled to processor 312. Processor312 may be any suitable software, firmware, hardware, or combinationthereof for processing signal 316. For example, processor 312 mayinclude one or more hardware processors (e.g., integrated circuits), oneor more software modules, computer-readable media such as memory,firmware, or any combination thereof. Processor 312 may, for example, bea computer or may be one or more chips (i.e., integrated circuits).Processor 312 may, for example, be configured of analog electroniccomponents. Processor 312 may perform the calculations associated withthe information determination techniques of the present disclosure aswell as the calculations associated with any calibration of processingsystem 300 or other auxiliary functions. For example, processor 312 maylocate one or more fiducial points in one or more signals, determine oneor more DPTTs, and compute one or more of a systolic blood pressure, adiastolic blood pressure and a mean arterial pressure. Processor 312 mayperform any suitable signal processing of signal 316 to filter signal316, such as any suitable band-pass filtering, adaptive filtering,closed-loop filtering, any other suitable filtering, and/or anycombination thereof. Processor 312 may also receive input signals fromadditional sources (not shown). For example, processor 312 may receivean input signal containing information about treatments provided to thepatient. Additional input signals may be used by processor 312 in any ofthe calculations or operations it performs in accordance with processingsystem 300.

Processor 312 may be coupled to one or more memory devices (not shown)or incorporate one or more memory devices such as any suitable volatilememory device (e.g., RAM, registers, etc.), non-volatile memory device(e.g., ROM, EPROM, magnetic storage device, optical storage device,flash memory, etc.), or both. The memory may be used by processor 312to, for example, store data corresponding to blood pressure monitoring,including current blood pressure calibration values, blood pressuremonitoring calibration thresholds, and patient blood pressure history.In an embodiment, processor 312 may store physiological measurements orpreviously received data from signal 316 in a memory device for laterretrieval. In an embodiment, processor 312 may store calculated values,such as a systolic blood pressure, a diastolic blood pressure, a bloodoxygen saturation, a differential pulse transit time, a fiducial pointlocation or characteristic, or any other calculated values, in a memorydevice for later retrieval.

Processor 312 may be coupled to a calibration device. This coupling maytake any of the forms described above with reference to calibrationdevice 80 within system 10. For example, the calibration device may be astand-alone device that may be in wireless communication with processor312, or may be completely integrated with processor 312.

Processor 312 may be coupled to a calibration device that may generate,or receive as input, reference measurements for use in calibrationcalculations. This coupling may occur through a recalibration signaltransmitted via a wired or wireless communications path. In anembodiment, processor 312 is capable of transmitting a command tocalibration device 80 to initiate a recalibration procedure.

Processor 312 may be coupled to output 314. Output 314 may be anysuitable output device such as one or more medical devices (e.g., amedical monitor that displays various physiological parameters, amedical alarm, or any other suitable medical device that either displaysphysiological parameters or uses the output of processor 312 as aninput), one or more display devices (e.g., monitor, PDA, mobile phone,any other suitable display device, or any combination thereof), one ormore audio devices, one or more memory devices (e.g., hard disk drive,flash memory, RAM, optical disk, any other suitable memory device, orany combination thereof), one or more printing devices, any othersuitable output device, or any combination thereof.

It will be understood that system 300 may be incorporated into system 10(FIGS. 1 and 2) in which, for example, input signal generator 310 may beimplemented as parts of sensor units 12 and 13 (FIGS. 1 and 2) andmonitor 14 (FIGS. 1 and 2) and processor 312 may be implemented as partof monitor 14 (FIGS. 1 and 2). In some embodiments, portions of system300 may be configured to be portable. For example, all or part of system300 may be embedded in a small, compact object carried with or attachedto the patient (e.g., a watch, other piece of jewelry, or a cellulartelephone). In such embodiments, a wireless transceiver (not shown) mayalso be included in system 300 to enable wireless communication withother components of system 10 (FIGS. 1 and 2). As such, system 10 (FIGS.1 and 2) may be part of a fully portable and continuous patientmonitoring solution. In such embodiments, a wireless transceiver (notshown) may also be included in system 300 to enable wirelesscommunication with other components of system 10. For example,pre-processor 320 may output signal 316 over BLUETOOTH, 802.11, WiFi,WiMax, cable, satellite, Infrared, or any other suitable transmissionscheme. In an embodiment, a wireless transmission scheme may be usedbetween any communicating components of system 300.

Pre-processor 320 or processor 312 may determine the locations of pulseswithin a periodic signal 316 (e.g., a PPG signal) using a pulsedetection technique. For ease of illustration, the following pulsedetection techniques will be described as performed by processor 312,but any suitable processing device (e.g., pre-processor 320) may be usedto implement any of the techniques described herein.

An illustrative PPG signal 400 is depicted in FIG. 4. Processor 312 mayreceive PPG signal 400, and may identify local minimum point 410, localmaximum point 412, local minimum point 420, and local maximum point 422in the PPG signal 400. Processor 312 may pair each local minimum pointwith an adjacent maximum point. For example, processor 312 may pairpoints 410 and 412 to identify one segment, points 412 and 420 toidentify a second segment, points 420 and 422 to identify a thirdsegment and points 422 and 430 to identify a fourth segment. The slopeof each segment may be measured to determine whether the segmentcorresponds to an upstroke portion of the pulse (e.g., a positive slope)or a downstroke portion of the pulse (e.g., a negative slope) portion ofthe pulse. A pulse may be defined as a combination of at least oneupstroke and one downstroke. For example, the segment identified bypoints 410 and 412 and the segment identified by points 412 and 430 maydefine a pulse.

According to an embodiment, PPG signal 400 may include a dichrotic notch450 or other notches (not shown) in different sections of the pulse(e.g., at the beginning (referred to as an ankle notch), in the middle(referred to as a dichrotic notch), or near the top (referred to as ashoulder notch)). Notches (e.g., dichrotic notches) may refer tosecondary turning points of pulse waves as well as inflection points ofpulse waves. Processor 312 may identify notches and either utilize orignore them when detecting the pulse locations. In some embodiments,processor 312 may compute the second derivative of the PPG signal tofind the local minima and maxima points and may use this information todetermine a location of, for example, a dichrotic notch. Additionally,processor 312 may interpolate between points in signal 316 or betweenpoints in a processed signal using any interpolation technique (e.g.,zero-order hold, linear interpolation, and/or higher-order interpolationtechniques). Some pulse detection techniques that may be performed byprocessor 312 are described in more detail in co-pending, commonlyassigned U.S. patent application Ser. No. 12/242,908, filed Sep. 30,2008 and entitled “SYSTEMS AND METHODS FOR DETECTING PULSES IN A PPGSIGNAL,” which is incorporated by reference herein in its entirety.

Metrics may be used to characterize or otherwise describe aphysiological signal. Metrics may include suitable signal values, signalmorphologies, output values from suitable operations performed on asignal or other metric, any other suitable mathematicalcharacterizations, or any suitable combinations thereof. For example,metrics may include pulse wave area (PWA), rate of change computed atone or more points of a time series (e.g., derivative of any suitableorder of a signal), statistics of a signal (e.g., mean, moment of anysuitable order, regression parameters), offset of a signal from abaseline, interval of portion of a signal (e.g., length of upstroke),relative position of a fiducial point of a signal (e.g., dichrotic notchposition), any other suitable metric or change thereof, or any suitablecombinations thereof. For example, in some embodiments, the skewness(e.g., the standardized third central moment) of a pulse wave may bemonitored.

Metrics may include mathematical manipulations of other metrics such as,for example, the value of an integral of a portion of a blood pressuremeasurement time series, the skewness of a derivative of a PPG signal,or any other suitable mathematical manipulations. In some embodiments,metrics may be computed from averaged, filtered, scaled, or otherwiseprocessed physiological signals. For example, a derivative may becomputed from a suitable ensemble average of pulse waves.

The term “pulse wave” as used herein refers to a portion of a PPG signalcorresponding to a physiological pulse.

A patient monitoring system may determine that values of one or moremetrics associated with a physiological signal correspond to storedvalues. The determination may be based at least in part on a comparisonof metric values to stored values by, for example, computing adifference. For example, a patient monitoring system may compute acurrent PWA of a current PPG signal by integrating a suitable portion ofthe PPG signal. The patient monitoring system may search among storedvalues of PWA associated with previous PPG signals. The patientmonitoring system may compute a difference between the current PWA valueand at least one of the stored PWA values. If the patient monitoringsystem determines that the difference in the current and stored PWAvalues is below a threshold, then the patient monitoring system maydetermine that the PWAs correspond to each other. Thresholds may bepredetermined, dynamic, constant, or any other suitable type of value,or any suitable combination thereof. For example, in some embodiments, athreshold may be ten percent of a metric value such that if thedifference between a value of a monitored metric and a stored value isless than ten percent of the monitored metric, the values are determinedto correspond. The selection of this threshold may be determined throughconsideration of previously acquired empirical data and the requiredaccuracy. In some embodiments, the required accuracy may change withcurrently reported blood pressure. For example, if a current bloodpressure measurement is outside normal physiological ranges, therequired accuracy may be tighter and the threshold may be set toencourage a cuff inflation, or true recalibration, rather than rely onan estimate calculated using historical data. In some embodiments, athreshold may be set with respect to a historical variation of themonitored metric, for example, at a fraction (e.g., 0.5) of one standarddeviation of the historic values of the monitored metric over a periodof time. Any suitable threshold may be used to aid in determiningwhether values correspond to each other. In some embodiments, thepatient monitoring system may determine whether a value of a monitoredmetric and a stored value to not correspond to one another.

In some embodiments, a difference vector including differences betweenvalues of monitored metrics and stored values may be computed by thepatient monitoring system. The Euclidean norm, or “norm”, of such avector may provide an indication of how closely the collective values ofmonitored metrics correspond to stored values. For example, a patientmonitoring system may compute differences between monitored values and aset of stored values of PWA, pulse wave skew, and length of pulse waveupstroke, and arrange the difference in each metric value in adifference vector. The patient monitoring system may compute the norm ofthe difference vector. If the norm is below a threshold value, thepatient monitoring system may determine that the current metricscorrespond to the stored metrics. Any suitable combination ofdifferences or other comparisons (e.g., norms, conditionalprobabilities) may be used by a patient monitoring system to determinewhether values correspond.

Shown in FIG. 5( a) is illustrative time series 500 of a blood pressuremeasurement in accordance with some embodiments. Changes in bloodpressure, or other suitable physiological metrics, may occur duringpatient monitoring. Changes in blood pressure, arterial compliance, orother physiological metrics, may result from, for example,administration of vasoactive drugs, changes in patient position, patientactivity, any other suitable event which may change the morphology of aphysiological signal or metric, or any combination thereof. In someembodiments, a patient monitoring system may be recalibrated in responseto changes in, for example, a PPG signal, a metric derived from a PPGsignal, any other suitable signal or metric, or any suitable combinationthereof.

Time series 500 shown in FIG. 5( a) includes multiple changes in bloodpressure such as, for example, those referenced by illustrative points512, 514, and 516. Time series 500 is observed to increase from point512 to point 514 over a first time interval, and then decrease frompoint 514 to point 516 over a second time interval. The blood pressurevalue at point 516 may, for example, substantially correspond to theblood pressure value at point 512. In some embodiments, a newcalibration at the time associated with point 514 may be desired as aresult of the blood pressure change from point 512 to point 514. In someembodiments, a new calibration at the time associated with point 516 maybe desired as a result of the blood pressure change from point 512 topoint 514, and then to point 516. The blood pressure values included intime series 500 may be computed based at least in part on a DPTTmeasurement, which may be based at least in part on the signals of twoPPG sensors placed at suitable locations on a patient.

Shown in illustrative FIGS. 5( b), 5(c), and 5(d) are illustrativegraphs showing time series 520, 540, and 560, respectively. Time series520, 540, and 560 may represent portions of one of the particular PPGsignals used by the patient monitor to compute DPTT values and the bloodpressure values of points 512, 514, and 516 of FIG. 5( a), respectively.Time series 520, 540, and 560, may each represent physiological pulseswhich may have occurred substantially at the times associated withpoints 512, 514 and 516, respectively. The ordinate of the illustrativegraphs shown in FIGS. 5( b), 5(c), and 5(d) may be scaled in arbitraryunits, while the abscissa of each of the graphs may be a normalized timevariable. For example, an abscissa value of zero represents the onset ofa particular pulse, and an abscissa value of one represents the end of aparticular pulse, with reference to FIGS. 5( b), 5(c), and 5(d).

Time series 520, 540, 560 may each have different morphologies due to,for example, physiological changes. In some embodiments, time series 520and 560 may have substantially similar morphologies as each other, whiletime series 540 may have a relatively different morphology from bothtime series 520 and 560. Shown in FIG. 6 is superposition 600 of timeseries 520, 540, and 560 of FIGS. 5( b), 5(c), and 5(d), respectively.It can be seen in FIG. 6, that time series 520 and 560 havesubstantially similar morphologies to each other. It can also be seen inFIG. 6, that time series 540 has a substantially different morphologyfrom both time series 520 and 560. For example, centroids 522 and 562derived from time series 520 and 560, respectively, are substantiallycoincident with each other, and are both substantially different fromcentroid 542 derived from time series 540. In a further example, thedichrotic notches of time series 520 and 560 both lie substantially innotch region 524. The dichrotic notch of time series 540 liessubstantially in notch region 544, located substantially apart fromnotch region 524.

Differences in metrics of one or more physiological signals such as, forexample, centroids (e.g., centroids 522, 542, and 562) or dichroticnotch positions (e.g., within notch regions 524 or 544) of pulse wavesof a PPG signal, may be monitored to determine when recalibration may bedesirous. For example, a patient monitoring system may have particularcalibration parameters at a time corresponding to point 512 of FIG. 5(a). Changes in arterial compliance, for example, may cause a change inblood pressure represented by the transition from point 512 to point 514in FIG. 5( a). The transition from point 514 to point 516 may, in someembodiments, represent a return by the patient to a similarphysiological state as that of point 512, indicated by the similar bloodpressure values displayed at points 512 and 516.

The patient monitoring system may determine that the physiological stateof the patient at point 516 is substantially similar to thephysiological state of the patient at point 512. This determination maybe based at least in part on the difference between the blood pressurevalues of points 512 and 516. For example, the patient monitoring systemmay compare the difference between the blood pressure values of points512 and 516 to a threshold. If the difference is less than thethreshold, the patient monitoring system may determine that the valuescorrespond. The patient monitoring system may determine that thephysiological states correspond based at least in part on thedetermination that the values correspond. The patient monitoring systemmay determine that the physiological states of the patient at points 512and 516 correspond, and the patient monitoring system may not perform acalibration (e.g., a cuff inflation) at a time corresponding to point516. Any suitable metrics, or combinations thereof, may be used todetermine whether physiological states of a patient correspond.

In some embodiments, metrics associated with the blood pressure patternfrom point 512 to point 514 to point 516 may be stored for laterreference. For example, administration of a particular drug to a patientmay cause the blood pressure change from point 512 to point 514, andthen to point 516. Metrics associated with this blood pressure changesuch as, for example, the time interval between points 512 and 516, peakto peak difference, slope of the time series 500 computed at suitablepoints, any other suitable metrics, or any suitable combinationsthereof, may be stored for future reference. For example, if the samedrug is administered at a new time, a new calibration may not berequired because stored calibration parameters corresponding to aprevious calibration, performed during a previous drug administration,may be recalled. Because the previous calibration may have beenperformed during a similar physiological state (e.g., for a similar drugadministration), the physiological signals may exhibit similar values ofsuitable metrics. In some embodiments, storing metrics associated with aphysiological signal may reduce the desired number of calibrations ofthe patient monitoring system.

In reference to FIG. 6, a patient monitoring system may store one ormore metrics associated with time trace 520 such as, for example, theposition (abscissa and ordinate values) of centroid 522. The patientmonitoring system may monitor a metric associated with a PPG signal suchas, for example, the position of the centroid of a pulse wave. Therelative centroid position may change from centroid 522 to centroid 542then to centroid 562, as shown in FIG. 6. The position of centroid 562may be determined by the patient monitoring system to correspond to theposition of centroid 522. The determination may be based at least inpart on, for example, differences between the abscissa and ordinatevalues of centroids 522 and 562. For example, the patient monitoringsystem may determine that the difference between both the abscissa andordinate values of centroids 522 and 562 are both within a threshold(e.g., five percent), and accordingly that centroids 522 and 562correspond to each other.

Shown in FIG. 7 is a block diagram of an illustrative database of storedvalues 700 in accordance with some embodiments. Stored values 700 mayinclude PPG data 702, blood pressure data 704, metrics 706 derived fromone or more PPG signals, patient monitoring system calibrationparameters 708, patient information 710 (e.g., physiologicalinformation, patient history, multi-patient sample statistics), mappings712, any other suitable data which may be stored in any suitablearrangement, or any suitable combinations thereof.

For example, PPG data 702 may include one or more data points sampledfrom a PPG signal, and stored in any suitable data format. PPG data 702may include data sampled at any suitable sampling frequency, datasampled at irregular intervals, or both. In some embodiments, PPG data702 may undergo mathematical manipulation such as, for example,smoothing, averaging (e.g., computing a moving average), re-sampling(e.g., sampling a subset of all data points), converting (e.g.,non-dimensionalizing, normalized, offset shifted), any other suitabledata processing technique, or any suitable combination thereof, prior tostorage.

Blood pressure data 704 may include blood pressure measurements (e.g., atime series) computed from one or more received signals (e.g., invasivearterial sensors, PPG sensors, inflatable cuff sensors). Blood pressuredata 704 may include, for example, systolic blood pressure, diastolicblood pressure, or both, or any suitable manipulation of any suitableblood pressure value. In some embodiments, blood pressure data 704 maybe smoothed, averaged, re-sampled, converted, mathematically manipulatedby any other suitable data processing technique or any combinationsthereof.

Metrics 706 may include any suitable value which may be derived from anysuitable signal (e.g., a PPG signal). For example, metrics 706 mayinclude derivatives of any suitable order, integrals, statistics (e.g.,mean, standard deviation, skew, kurtosis), regressions of any form andorder, ordinate values, abscissa values, any other suitable metrics,evaluated at any suitable point or combination of points, which may becomputed from a suitable signal, or any suitable combinations thereof.For example, in some embodiments, metrics 706 may include pulse rate,pulse wave area, dichrotic notch position, skew of a portion of a PPGsignal, skew of the derivative of a portion of a PPG signal, upstrokelength of a pulse wave, pulse wave height, pulse wave full width at halfmaximum (FWHM), any other suitable metric, or any suitable combinationsthereof.

In some embodiments, PPG signals, data derived from any suitable signal,or combinations thereof, may be approximated by any suitable continuousor non-continuous function, basis set (e.g., orthogonal functions),expression, or suitable combination thereof in any suitable variablespace. In some embodiments, for example, metrics 706 may include values,parameters, coefficients, boundary conditions, or other descriptorsassociated with a Fourier series, Fourier integral, Bessel function,Legendre polynomial, Chebyshev polynomial, Laguerre polynomial, discreteor continuous transform (e.g., Laplace, Fourier, wavelet), any othersuitable basis set, expression, transform, or function, or any suitablecombinations thereof. For example, the output of a fast Fouriertransform (FFT) of portions of a sampled (e.g., discreet) PPG signal maybe stored in accordance with metrics 706. In some embodiments, metrics706 may include the coefficients A_(i) (e.g., weighting functions,constants) of any suitable superposition (e.g., linear combination overindex i) of expressions f(x_(j)) depending on any suitable number ofvariables x_(j), which may be used to approximate one or more values Mof a metric, as illustratively shown by

$\begin{matrix}{M \approx {\sum\limits_{i = 1}^{N}{A_{i}{{f_{i}\left( x_{j} \right)}.}}}} & (19)\end{matrix}$A summation, such as that given by Eq. 19, may be used to approximate aportion of a signal (e.g., a signal feature corresponding to aphysiological pulse), a metric time series, any other suitable values,or any combination thereof. It will be understood that the approximationsign in Eq. 19 may be replaced with an equal sign in suitablecircumstances. In some embodiments, with reference to Eq. 19, more thanone summation may be performed over any suitable number of indices.

Stored values 700 may include calibration parameters 708, which may beused to calibrate any suitable device (e.g., a sensor), system (e.g., apatient monitoring system), process, any other suitable hardware orsoftware which may be used to perform a measurement, or any suitablecombinations thereof. For example, in some embodiments, calibrationparameters 708 may include a, b, and c_(i) of Eqs. 14-18. Calibrationparameters 708 may, for example, be stored and indexed with metricscomputed substantially at a time when the calibration was performed.

Stored values 700 may include patient information 710, which may includeinter-patient information, intra-patient information, patient histories,statistical information, any other information associated with one ormore patients, or any combination of information thereof. For example,in some embodiments, patient information 710 may include patient medicalhistories, medication information, patient allergies, patient monitoringhistories (e.g., previous physiological state information), patientidentification information, any other suitable information, or anycombination thereof.

Stored values 700 may include mappings 712, which may include anysuitable type of distribution functions, functions with any suitablenumber of variables, expressions with any suitable number of variables,any other suitable correlations, or any suitable combinations thereof.In some embodiments, mappings 712 may include a probability distributionfunction (PDF), cumulative distribution function (CDF), conditional PDF,conditional CDF, multivariable function, differential equation, crosscorrelation, interpolation, any other suitable mathematical orcomputational tool for relating sets or variables, or any combinationsthereof. For example, in some embodiments, mappings 712 may include afunction such as that given byM≈f(x ₁ ,x ₂ , . . . x _(N)),  (20)wherein x_(i) may be suitable parameters, metrics, or other values, andM may be any suitable metric value. In a further example, only discreetvalues of values x_(i) may be defined (e.g., only integers, evenlyspaced discreet values), and a suitable interpolation may be used todetermine M values based on x_(i) values intermediate to the discreetx_(i) values. It will be understood that the approximation sign in Eq.20 may be replaced with an equal sign in suitable circumstances.

Stored values 700 may be stored in any suitable memory device orcombination of memory devices. Stored values 700 may be stored remotely(e.g., in remote memory 90 of FIG. 1), locally (e.g., in ROM 52 of FIG.1), or any suitable combination thereof. For example, in someembodiments, a database of stored values 700 may be catalogued andindexed as a lookup table, in which stored values 700 may be stored inone or more memory devices. Any suitable data structure may be used toindex stored values 700, including, for example, tree structures, arraystructures (e.g., vectors, images), mappings, any other suitable datastructure, or any suitable combinations thereof. Any of stored values700 may be associated, indexed, catalogued, or otherwise related to anyother of stored values 700. For example, a particular value of metric706 may be associated with a particular set of calibration parameters708. The particular set calibration parameters 708 may be recalled bythe patient monitoring system if a monitored metric is determined tosubstantially correspond to the particular value of metric 706.

In some embodiments, a patient monitoring system may decide not toperform a calibration if it determines that a monitored metriccorresponds to a particular value of a stored metric 706. In someembodiments, a patient monitoring system may determine that the currentcalibration parameters are appropriate based at least in part on valuesof one or more monitored metrics. For example, a patient monitoringsystem may determine that a patient's current physiological statecorresponds to a previous physiological state of the patient. If, forexample, the current calibration parameters were taken during theprevious physiological state, and are still appropriate, the patientmonitoring system may determine that a recalibration is not desired.

Shown in FIG. 8 is flow diagram 800 of an illustrative process forupdating monitoring system calibration parameters in accordance with anembodiment. Illustrative step 802 may include receiving at least onesignal to the signal input of a patient monitoring system (e.g., patientmonitoring system 10 of FIG. 1). Illustrative step 804 may includemonitoring the value of at least one metric derived from the receivedsignal (e.g., a PPG signal). Illustrative step 806 may include comparingthe monitored metric value to a stored value (e.g., any of stored values700 of FIG. 7). Illustrative determination step 808 may includedetermining whether the monitored metric value corresponds to the storedvalue. Illustrative step 810 may include updating calibration parametersof a patient monitoring system (e.g., patient monitoring system 10 ofFIG. 1).

Step 802 of FIG. 8 may include receiving any suitable physiologicalsignal such as, for example, a PPG signal. In some embodiments, thesignal may be sampled at any suitable sampling frequency by a patientmonitoring system. In some embodiments, more than one signal may bereceived in accordance with step 802. For example, in some embodiments,two PPG signals may be received by a patient monitoring system (e.g., tocalculate a DPTT value).

Step 804 of FIG. 8 may include monitoring any suitable metric valuewhich may be derived from a received signal (e.g., the signal of step802). For example, the value of metrics such as blood pressure, heartrate, DPTT, signal morphology (e.g., pulse wave area, pulse wave moment,relative fiducial point position), any other suitable metrics, or anysuitable combinations thereof, may be monitored by a patient monitoringsystem at step 804. In some embodiments, step 804 may include a patientmonitoring system storing, recalling, deleting, displaying or otherwisemanaging metric values derived from any suitable received signal. Forexample, in some embodiments, a patient monitoring system may store ametric value in queue (e.g., in a suitable memory device), and replacethe value with a new value at a later time.

Step 806 of FIG. 8 may include comparing a monitored metric value (e.g.,metric value of step 804) to a stored value (e.g., any of stored values700 of FIG. 7). In some embodiments, step 806 may include determining adifference between a monitored metric value and a stored value. Thedifference may include computations such as subtraction, normalization,division, any other suitable operation, or any suitable combinationthereof, of the monitored metric value and the stored value. In someembodiments, a difference may be compared to a threshold value. Thethreshold value may, for example, be a stored value, a user definedvalue, a substantially real-time value computed based at least in parton a received signal, a monitored metric, a value derived from any otherformulation, or any suitable combination thereof. In some embodiments,the stored value may be recalled from any suitable database(s) stored insuitable memory device(s), as shown illustratively by step 850. Step 850may include parsing data, interpolating data, requesting values,searching data structures, traversing data structures (e.g., arrays,trees, multimaps), any other suitable technique for accessing a storedvalue, or any suitable combination thereof.

In some embodiments, any suitable pattern matching technique, patternrecognition technique, or other classification technique, or combinationof techniques, may be used to compare metricsat step 806 of FIG. 8. Forexample, templates, classifications (e.g., k-nearest neighboralgorithms, decision trees), regressions (e.g., neural networks), anyother pattern recognition techniques, or any suitable combinationthereof may be used to compare or match the value of a monitored metricto a stored value.

If the patient monitoring system does not locate a suitable storedvalue, step 860 may be performed (see step 1060 of flow diagram 1000 ofFIG. 10). Step 860 may include determining a morphology change,performing a calibration, storing values in memory, any other suitableactions, or any combination thereof. For example, if the patientmonitoring system cannot locate a suitable stored value for comparison,the patient monitoring system may store one or more current metricvalues so that stored metric values may be available in the future.

Determination step 808 of FIG. 8 may include, for example, determiningwhether a monitored metric value corresponds to a stored metric value.In some embodiments, a comparison of the monitored metric value and thestored value may be used at determination step 808. For example, in someembodiments, a monitored metric value may be determined to correspond toa stored value if a computed difference between the two values is lessthan a particular threshold value.

It may be determined, for example, at determination step 808 that amonitored metric does not correspond to a stored value. In response tosuch a determination, the patient monitoring system may, in someembodiments, initiate step 802, 804, or 806. In some embodiments, themonitored metric value may be compared to further stored values at step808. In some embodiments, the patient monitoring system may compute anew value for the monitored metric and compare the new value to a storedvalue at determination step 808.

In some embodiments, the patient monitoring system may determine that amonitored metric does not correspond to a stored value. In response tosuch a determination, the patient monitoring system may, in someembodiments, perform step 860 (see step 1060 of flow diagram 1000 ofFIG. 10). For example, the patient monitoring system may determine thatthe monitored metric does not correspond to a stored value, and that acalibration is desired. One or more metric values corresponding to thecalibration may be stored for future reference as stored values.

If the value of a monitored metric is determined to correspond to astored value, calibration parameters may be updated in accordance withstep 810 of FIG. 8. Step 810 may include, for example, recallingcalibration parameters (e.g., a, b and/or c_(i) of Eqs. 14-18) from amemory device, replacing calibration parameters with stored calibrationparameters, determining a blood pressure measurement based on storedcalibration parameters, any other suitable process, or any suitablecombination thereof. In some embodiments, calibration parametersassociated with the stored value may be recalled and used in the currentcalibration.

In an illustrative example, two PPG signals may be received by a patientmonitoring system (e.g., patient monitoring system 10 of FIG. 1) at step802 of FIG. 8. A metric such as, for example, the DPTT derived from thereceived signals may be computed as a time series by the patientmonitoring system at step 804 of FIG. 8. The patient monitoring systemmay compare one or more DPTT values to a suitable stored DPTT value in asuitable memory device (e.g., ROM 52, remote memory 90, or both, of FIG.1). The stored DPTT value may be recalled by the patient monitoringsystem by suitable searching of a catalogue of stored metric valuesstored in a suitable database. If the patient monitoring systemdetermines that the monitored DPTT value corresponds substantially to astored DPTT value, the patient monitoring system may recall calibrationparameters associated with the stored DPTT value. The patient monitoringsystem may update the current blood pressure calibration values (e.g.,a, b and/or c_(i) of Eqs. 14-18) with the blood pressure calibrationvalues associated with the stored DPTT value. Although the previousexample discloses monitoring a DPTT value and updating blood pressurecalibration parameters, the value of any suitable metric may bemonitored, and any suitable calibration parameters may be updated.

Shown in FIG. 9 is flow diagram 900 of an illustrative process forstoring physiological signals, metrics, or both, in accordance with anembodiment. Illustrative step 902 may include a patient monitoringsystem (e.g., patient monitoring system 10 of FIG. 1) receiving at leastone signal. Illustrative step 904 may include computing the value of atleast one metric based at least in part on the received signal (e.g., aPPG signal). Illustrative step 906 may include storing the monitoredmetric value in any suitable memory device (e.g., ROM 52, remote memory90, or both, of FIG. 1). Illustrative determination step 908 may includecataloguing the stored metric value in a suitable database.

Step 902 of FIG. 9 may include receiving any suitable physiologicalsignal such as, for example, a PPG signal. In some embodiments, thesignal may be sampled at any suitable sampling frequency allowing thesignal to be monitored by a patient monitoring system. In someembodiments, more than one signal may be received at step 902. Forexample, in some embodiments, two PPG signals may be received by apatient monitoring system.

Step 904 of FIG. 9 may include determining (e.g., computing) anysuitable metric value that may be derived from a received signal of step902. For example, the value of metrics such as blood pressure, pulserate, DPTT, signal morphologies (e.g., pulse wave area, pulse wavemoment, relative fiducial point position, skewness, kurtosis), any othersuitable metrics, or any combinations thereof, may be monitored by asuitable patient monitoring system at step 904. In some embodiments, apatient monitoring system may store (e.g., to a queue), recall (e.g.,from a queue), delete, display or otherwise manage one or more metricvalues derived at least in part from any suitable received signal atstep 904.

Step 906 of FIG. 9 may include storing, cataloguing, or both, anysuitable metric value in any suitable memory storage device. Forexample, in some embodiments, a patient monitoring system may create oraddend a database any of stored values 700 of FIG. 7. For example, insome embodiments, patient information 710 may be appended withinformation regarding a new patient. In a further example, multiplevalues of a particular metric may be stored and used as a training seton which a correlation or PDF may be based.

In some embodiments, metric values may be stored and then catalogued(e.g., indexed by value and storage location). In some embodiments,metric values may be catalogued and then stored (e.g., stored inparticular locations based at least in part on metric value). Metricvalues may be associated with any of stored values 700 duringcataloguing, in some embodiments.

In some embodiments, step 950 of FIG. 9 may correspond substantially tostep 850 of FIG. 8. For example, values catalogued, stored, or both, atstep 906 of FIG. 9 may be recalled or otherwise identified at step 806of FIG. 8. In some embodiments, a suitable combination of steps 850 and950 may allow a suitable database to be created, appended, or otherwisemaintained, and any data stored within to be recalled at a suitable time(e.g., in response to a request).

Shown in FIG. 10 is flow diagram 1000 of an illustrative process forstoring physiological signals, metrics, or both, corresponding to acalibration in accordance with an embodiment. Illustrative step 1002 mayinclude a patient monitoring system (e.g., patient monitoring system 10of FIG. 1) receiving at least one signal. Illustrative step 1004 mayinclude computing the value of at least one metric based at least inpart on the at least one received signal (e.g., a PPG signal).Illustrative determination step 1006 may include determining a change inone or more metric values. Illustrative determination step 1008 mayinclude calibrating one or more sensors of a patient monitoring system.Illustrative step 1010 may include storing one or more metric value inany suitable memory device (e.g., ROM 52, remote memory 90, or both, ofFIG. 1).

Step 1002 of FIG. 10 may include receiving any suitable physiologicalsignal such as, for example, a PPG signal. In some embodiments, thesignal may be sampled at any suitable sampling frequency allowing thesignal to be monitored by a patient monitoring system. In someembodiments, more than one signal may be received at step 1002. Forexample, in some embodiments, two PPG signals may be received by apatient monitoring system.

Step 1004 of FIG. 10 may include determining (e.g., computing) anysuitable metric value that may be derived from a received signal of step1002. For example, the value of metrics such as blood pressure, pulserate, DPTT, signal morphologies (e.g., pulse wave area, pulse wavemoment, relative fiducial point position, skewness, kurtosis), any othersuitable metrics, or any combinations thereof, may be monitored by asuitable patient monitoring system at step 1004. In some embodiments, apatient monitoring system may store (e.g., to a queue), recall (e.g.,from a queue), delete, display or otherwise manage one or more metricvalues derived at least in part from any suitable received signal atstep 1004.

Step 1006 may include determining a change in one or more metric values.In some embodiments, a change in one or metric values may be a changefrom a constant or historical metric values. In some embodiments, achange in metric value may be a change in a derivative of one or moremetrics. The value of one or more metrics may be compared to a thresholdto aid in determining whether the metric value has changed. For example,if the difference between a monitored metric value and threshold valueis computed to be greater than ten percent of the monitored metricvalue, the patient monitoring system may determine that the monitoredmetric has changed. In some embodiments, a user (e.g., a clinician) maydetermine that a metric value has changed and the patient monitoringsystem may receive user input indicating the change.

In some embodiments, a stored value may not be available at step 1006 toaid in determining whether a metric has changed. For example, thepatient monitoring system may determine that one or more particularmetric values do not correspond to any available stored values. Forexample, the patient monitoring system may determine that the bloodpressure has changed if the blood pressure measurement changes by morethan one standard deviation from a historical measurement (e.g., a timeseries of blood pressure measurements). In some embodiments, step 860 ofFIG. 8 may correspond to step 1060 of FIG. 10.

Step 1008 of FIG. 10 may include performing a calibration measurement ifone or more metric values are determined to have changed. Thecalibration may include performing a NIBP measurement, updating ameasurement (e.g., a displayed blood pressure measurement), calibratingone or more devices (e.g., two PPG sensors), any other suitable action,or any combination thereof.

In some embodiments, step 1008 may be performed in response to a lack ofstored values being available. For example, if a particular metric isdetermined to have changed, but no stored values are available whichcorrespond to the metric value, the patient monitoring system mayperform a calibration (e.g., perform a cuff inflation).

Step 1010 of FIG. 10 may include storing metric values, calibrationparameters, or both, in any suitable memory storage device. In someembodiments, step 1010 may append a database such as a look-up tablewith one or more metric values, calibration parameters, signal values,any other suitable values associated with the calibration of step 1008,or any combination thereof. In some embodiments, step 1010 may allow oneor more current metrics to be stored for future reference. For example,in some embodiments, a patient monitoring system may create or addend adatabase any of stored values 700 of FIG. 7. For example, in someembodiments, patient information 710 may be appended with informationregarding a new patient. In a further example, multiple values of aparticular metric may be stored and used as a training set on which acorrelation or PDF may be based.

In some embodiments, metric values may be stored and then catalogued(e.g., indexed by value and storage location). In some embodiments,metric values may be catalogued and then stored (e.g., stored inparticular locations based at least in part on metric value). Metricvalues may be associated with any of stored values 700 duringcataloguing, in some embodiments.

It will be understood that the steps of flow diagrams 800, 900, and 1000of FIGS. 8-10, respectively, are illustrative. Any of the steps of flowdiagrams 800, 900, and 1000 may be modified, omitted, rearranged,combined with other steps of flow diagrams 800, 900, and 1000, orsupplemented with additional steps, without departing from the scope ofthe present disclosure.

What is claimed is:
 1. A system for determining blood pressure of asubject, the system comprising: a signal input configured to receivefrom a sensing device a photoplethysmograph (PPG) signal indicative ofan amount of light absorbed by a tissue of the subject; a processorcoupled to the signal input, wherein the processor is configured to:monitor a metric derived at least in part from the PPG signal; determinea first set of calibration parameters associated with a first value ofthe metric, wherein the first set of calibration parameters is usablefor calculating blood pressure of the subject; store the first set ofcalibration parameters and the associated first value of the metric;determine a second set of calibration parameters associated with asecond value of the metric, wherein the second set of calibrationparameters is usable for calculating the blood pressure of the subject;store the second set of calibration parameters and the associated secondvalue of the metric; determine a current value of the metric based atleast in part on the PPG signal; select one of the first and second setsof calibration parameters based at least in part on the current value ofthe metric; and determine a blood pressure value of the subject based atleast in part on the PPG signal and the selected one of the first andsecond sets of calibration parameters; and a display device coupled tothe processor, wherein the display device is configured to display thedetermined blood pressure value.
 2. The system of claim 1, wherein themetric comprises at least one of a differential pulse transit time, ablood pressure, a heart rate, a PPG signal derivative, a PPG signalintegral, a PPG signal moment, a PPG signal domain, a PPG signal range,a PPG signal peak value, a PPG signal morphology metric, a coefficientof a PPG signal transform, and a combination thereof.
 3. The system ofclaim 1, further comprising a memory storage device coupled to theprocessor, wherein the first and second sets of calibration parametersand the associated first and second values of the metric are stored inthe memory storage device.
 4. The system of claim 1, wherein theprocessor is coupled to a memory storage device remote from the system,and wherein the first and second sets of calibration parameters and theassociated first and second values of the metric are stored in theremote memory storage device.
 5. The system of claim 1, wherein theprocessor is further configured to: compare the current value of themetric to the first and second values of the metric to determine if thecurrent value corresponds to the first or second value; and recall theassociated first or second set of calibration parameters if the currentvalue corresponds to the first or second value of the metric.
 6. Thesystem of claim 5, wherein the processor is further configured to:perform a calibration to determine a third set of calibration parametersassociated with a third value of the metric if a current value of themetric does not correspond to at least one of the first and secondvalues of the metric; store the third set of calibration parameters andthe associated third value of the metric; and determine a blood pressurevalue based on the third set of calibration parameters.
 7. The system ofclaim 5, wherein comparing the current value of the metric to the firstand second values of the metric further comprises: determining adifference between the current value and the first value of the metric;determining a difference between the current value and the second valueof the metric; and comparing the differences to a threshold to determineif the current value corresponds to at least one of the first and secondvalues.
 8. The system of claim 5, wherein the comparing the currentvalue of the metric to the first and second values of the metric furthercomprises using a pattern recognition technique.
 9. The system of claim1, wherein the processor is further configured to: generate a databasecomprising the first and second values of the metric and the associatedfirst and second sets of calibration parameters; and append subsequentlyobtained additional values of the metric and associated additional setsof calibration parameters to the database.
 10. The system of claim 1,wherein the metric comprises a first metric, and wherein the processoris further configured to: monitor a second metric derived at least inpart from the PPG signal; determine additional sets of calibrationparameters associated with subsequently obtained additional values ofthe second metric; store the additional sets of calibration parametersand associated additional values; and determine the blood pressure ofthe subject based at least in part on the PPG signal, at least one ofthe first metric and the second metric, and at least one of the first,second, and additional sets of calibration parameters.
 11. A method fordetermining blood pressure of a subject, the method comprising:receiving a photoplethysmograph (PPG) signal from a pulse oximetrysensor; monitoring, using a processor coupled to the pulse oximetrysensor, a metric derived, by the processor, at least in part from thePPG signal; determining, using the processor, a first set of calibrationparameters associated with a first value of the metric, wherein thefirst set of calibration parameters is usable for calculating bloodpressure of the subject; storing, to a memory storage device coupled tothe processor, the first set of calibration parameters and theassociated first value of the metric; determining, using the processor,a second set of calibration parameters associated with a second value ofthe metric, wherein the second set of calibration parameters is usablefor calculating the blood pressure of the subject; storing, to thememory storage device, the second set of calibration parameters and theassociated second value of the metric; determining, using the processor,a current value of the metric based at least in part on the PPG signal;selecting, using the processor, one of the first and second sets ofcalibration parameters based at least in part on the current value ofthe metric; determining, using the processor, a blood pressure value ofthe subject based at least in part on the PPG signal and the selectedone of the first and second sets of calibration parameters; andoutputting, to a display device coupled to the processor, the determinedblood pressure value of the subject for display.
 12. The method of claim11, wherein the metric comprises at least one of a differential pulsetransit time, a blood pressure, a heart rate, a PPG signal derivative, aPPG signal integral, a PPG signal moment, a PPG signal domain, a PPGsignal range, a PPG signal peak value, a PPG signal morphology metric, acoefficient of a PPG signal transform, and a combination thereof. 13.The method of claim 11, wherein the memory storage device is remote fromthe processor.
 14. The method of claim 11, further comprising:comparing, using the processor, a current value of the metric to thefirst and second values of the metric to determine if the current valuecorresponds to the first or second value; and recalling, from the memorystorage device, the associated first or second set of calibrationparameters if the current value corresponds to the first or second valueof the metric.
 15. The method of claim 14, further comprising:performing, using a calibration device coupled to the processor, acalibration to determine a third set of calibration parametersassociated with a third value of the metric if a current value of themetric does not correspond to at least one of the first and secondvalues of the metric; storing, to the memory storage device, the thirdset of calibration parameters and the associated third value of themetric; and determining, using the processor, the blood pressure basedon the third set of calibration parameters.
 16. The method of claim 14,wherein the comparing the current value of the metric to the first andsecond values of the metric further comprises: determining a differencebetween the current value and the first value of the metric; determininga difference between the current value and the second value of themetric; and comparing the differences to a threshold to determine if thecurrent value corresponds to at least one of the first and secondvalues.
 17. The method of claim 14, wherein the comparing the currentvalue of the metric to the first and second values of the metric furthercomprises using a pattern recognition technique.
 18. The method of claim11, further comprising: generating, in the memory storage device, adatabase comprising the first and second values of the metric and theassociated first and second sets of calibration parameters; andappending subsequently obtained additional values of the metric andassociated additional sets of calibration parameters to the database.19. The method of claim 18, further comprising: searching the databasefor values corresponding to a current value of the metric; recalling,from the database, a set of calibration parameters associated with thevalue corresponding to the current value of the metric; and determining,using the processor, the blood pressure based on the associated set ofcalibration parameters.